Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature

Abstract

Purpose of Review This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED. Recent Findings The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized. Summary Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.

Latest Advances in Regional Anaesthesia

“…As such, the ESP block is often compared with the paravertebral block (PVB), due to their similar target areas, but is associated with fewer complications [13,14]. ESP blocks (Figure 1) are also favoured for the wide anatomical area they can cover with a single injection resulting in effects at multiple vertebral levels: typically three in a cranial and three in a caudal direction [9,[21][22][23][24]. For example, evidence shows that an ESP block performed at the level of T5 will result in analgesia from T3-T9 [17].…”

“…In emergency departments, regional techniques can be used for the management of pain relating to trauma such as rib and hip fractures. This has been shown to have positive effects with respect to opioid use, patient satisfaction, and hospital length of stay [24,66,67]. An acute pain service is an integral function in large institutions dealing with major surgery and trauma [68].…”

“…An acute pain service is not limited to surgical patients and may also manage injuries that warrant conservative management. Equally, these injuries may be managed earlier in a patient's presentation by non-anaesthetists in the emergency department [24]. Examples of such injuries include, but are not limited to rib fractures, pubic rami fractures, clavicle fractures, and soft tissue injuries.…”

The Future of Ultrasound for Acute Pain and Invasive Procedures in Anesthesia and Emergency Medicine Training Programs

“…Uncontrolled acute pain leads to worse quality of life and development of chronic pain [3], while sufficient pain relief is associated with a decrease in cost [4] and duration of hospitalization [5]. Regional anesthesia techniques, particularly peripheral nerve blocks (PNB), have become commonplace as part of a multimodal perioperative pain relief approach and have also increased in popularity over the past decade in the emergency department [6], with the most common being interscalene, supraclavicular, and suprascapular nerve blocks [7]. The use of ultrasound guidance has helped facilitate visualization of desired nerves for anesthesia and aided the adoption of regional anesthesia into medical practice.…”

Ultrasound-Guided Nerve Blocks: Suggested Procedural Guidelines for Emergency Physicians

“…Ultrasound-guided nerve blocks (UGNB) are a core element of this multifaceted approach to pain [6][7]. Although traditionally used by anesthesiologists for intraoperative anesthesia and the management of post-operative pain, targeted UGNB can also significantly reduce acute pain in ED patients [8][9][10][11][12][13][14][15][16][17][18]. When performed by trained EM physicians, UGNB may also decrease unintended side effects from opioids and procedural sedation, such as hypotension and respiratory depression [19][20].…”